A Study of Patients who leave the Accident & Emergency Department against Medical Advice: An Eastern Nigeria Tertiary Institution Experience

The concept of patients leaving the Accident & Emergency Department against medical advice, Discharging Against Medical Advice (DAMA) or Signing Against Medical Advice (SAMA) is a common occurrence in our sub-region. These groups of patients are often considered high-risk, as they are prone to complications from seeking alternative healthcare services, which might be detrimental to their health. The objective was to determine the characteristics of patients signing against medical advice and the subspecialty with the highest prevalence of patients leaving the hospital against medical advice. A quantitative cross-sectional study design was chosen to accomplish the objectives of the study. A retrospective study was carried out in the Accident & Emergency Department (A & ED) of Federal Medical Center, Owerri (FMCO), to determine the characteristics of this distinct group of patients who left the hospital against medical advice. A review of the records of all patients who left against medical advice between 1st of August 2012 and 31st of July 2014 was done. There were 137 DAMA cases during the study period. The mean age of the DAMA study group was 32.3 years +/- 15.9. The major subspecialty involved was Orthopedics and Trauma with 51.8% (n = 71). The modal age group was between 21 – 30 years with 41.6% (n = 57) while 77.4% were males. In conclusion younger males with orthopedics and trauma cases were the most involved in DAMA and so this group of patients should be counseled as soon as they arrive the Accident and Emergency Department. A further study is needed to find out where they go and their outcome.